Transoral robotic resection of a lingual thyroid: a novel treatment for obstructive sleep apnoea

2021 ◽  
Vol 14 (9) ◽  
pp. e241412
Author(s):  
Jon Curtis ◽  
Sophie Walford ◽  
David Howe
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Thyroid Tissue ◽  
Sleep Apnoea ◽  
Lingual Thyroid ◽  
Thyroid Function Tests ◽  
Dental Infection ◽  
Management Options ◽  
En Bloc ◽  
Obstructive Sleep ◽  
Robotic Resection

A 34-year-old woman with a history of congenital hypothyroidism and 15 years of obstructive sleep apnoea was admitted with a left submandibular swelling secondary to a dental infection. A CT scan of the neck identified an incidental 27 mm tongue base mass and the absence of any cervical thyroid tissue. This mass was not observable on examination of the oropharynx but was seen on fine nasendoscopy while thyroid function tests showed good thyroid stimulating hormone suppression. Her acute dental infection was treated and, following multidisciplinary team discussion, she was diagnosed with an ectopic lingual thyroid. She was offered different management options including no intervention and radio-iodide treatment but opted for transoral robotic resection. The lesion was resected en bloc with clear margins and histology confirmed lingual thyroid tissue. Since the procedure, she has remained free of sleep apnoea with a significantly improved quality of life.

scholarly journals Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

2022 ◽  
Vol 8 ◽  
Author(s):  
Miuni Athauda Arachchige ◽  
Joerg Steier
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Team Approach ◽  
Cpap Therapy ◽  
Management Options ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Increased Risk

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

An unusual cause of obstructive sleep apnoea presenting during pregnancy

1998 ◽  
Vol 112 (12) ◽  
pp. 1189-1191 ◽  
Author(s):  
Khalid Taibah ◽  
Mohammad Ahmed ◽  
Ebtessam Baessa ◽  
Muhammad Saleem ◽  
Ayman Rifai ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Mixed Type ◽  
Sleep Apnoea ◽  
Primary Hypothyroidism ◽  
Accurate Diagnosis ◽  
Dramatic Improvement ◽  
Lingual Thyroid ◽  
Central Type ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep

AbstractWe describe a case of lingual thyroid (LT) with primary hypothyroidism, presenting during pregnancy and continuing beyond it with oropharyngeal obstructive symptoms and sleep apnoea syndrome (SAS) of mixed type. Although SAS of a combined obstructive and central type should not be too surprising in a case of LT with hypothyroidism, we were unable to find such a documentation previously. Only four weeks of L-thyroxin treatment resulted in a dramatic improvement in dysphagia, disturbed phonation, haemoptysis, arterial desaturation, sleep apnoea and overall sleep efficiency, in conjunction with a regression in the size of the lingual mass. This case highlights the vagaries confronted in the management of such a case and focuses on efforts towards accurate diagnosis and treatment.

The severity of obstructive sleep apnoea does not influence ambient IGF-I levels

2017 ◽  
Author(s):  
Julie Lynch ◽  
Nikolaos Kyriakakis ◽  
Mark Elliott ◽  
Dipansu Ghosh ◽  
Mitchell Nix ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Igf I

Requirement of staged interventions in a complex case of Acromegaly and Obstructive Sleep Apnoea

2020 ◽  
Author(s):  
Mili Dhar ◽  
Jennifer Elias ◽  
Benjamin Field ◽  
Sunil Zachariah ◽  
Julian Emmanuel
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Complex Case ◽  
Obstructive Sleep

Obstructive sleep apnoea is highly prevalent in a bariatric surgical population

2020 ◽  
Author(s):  
Rachel Agius ◽  
Claudia Coelho ◽  
James Crane ◽  
Piya Sen Gupta ◽  
Barbara McGowan
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep

What Non-Alcoholic Fatty Liver Disease Has Got to Do with Obstructive Sleep Apnoea Syndrome and viceversa?

2014 ◽  
Vol 23 (3) ◽  
pp. 291-299 ◽  
Author(s):  
Giovanni Tarantino ◽  
Vincenzo Citro ◽  
Carmine Finelli
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Obstructive Sleep Apnoea ◽  
Fatty Liver Disease ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Alcoholic Fatty Liver ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea syndrome (OSAS) are common conditions, frequently encountered in patients with obesity and/or metabolic syndrome. NAFLD and OSAS are complex diseases that involve an interaction of several intertwined factors. Several lines of evidence lend credence to an immune system derangement in these patients, i.e. the low grade chronic inflammation status, reckoned to be the most important factor in causing and maintaining these two illnesses. Furthermore, it is emphasized the main role of spleen involvement, as a novel mechanism. In this review the contribution of the visceral adiposity in both NAFLD and OSAS is stressed as well as the role of intermittent hypoxia. Finally, a post on the prevention of systemic inflammation is made.Abbreviations: ALT: alanine aminotransferase; BMI: body mass index; CCR2: chemokine (C-C motif) receptor 2; CRP: C-reactive protein; CPAP: continuous positive airway pressure; FFA: free fatty acid; IGF-I: insulin-like growth factor; IR: insulin resistance; IL-6: interleukin-6; IH: intermittent hypoxia; IKK-β: IκB kinase β; LPS: lipopolysaccharide; MCP-1: monocyte chemoattractant protein-1; NAFLD: non-alcoholic fatty liver disease; NASH: nonalcoholic steatohepatitis; NEFA: non-esterified fatty acid; NF-κB: nuclear factor-κB; OSAS: obstructive sleep apnoea syndrome; PAI-1: plasminogen activator inhibitor-1; ROS: reactive oxygen species; TNF-α: tumor necrosis factor-α; T2D: type 2 diabetes.

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